1.

Dose-related adverse drug reactions represent an exaggeration of the drug's

therapeutic effects. For example, a person taking a drug to reduce high blood pressure may
feel dizzy or light-headed if the drug reduces blood pressure too much. A person with
diabetes may develop weakness, sweating, nausea, and palpitations if insulin or an oral
antidiabetic drug reduces the blood sugar level too much. This type of adverse drug reaction
is usually predictable but sometimes unavoidable. It may occur if a drug dose is too
high (overdose reaction), if the person is unusually sensitive to the drug, or if another drug
slows the metabolism of the first drug and thus increases its level in the blood (see Drug
Interactions). Dose-related reactions are usually not serious but are relatively common.

Drug-Nutrient Interactions
Nutrients include food, beverages (including alcohol), and dietary supplements. Consumption of
these substances may alter the effects of drugs the person takes.

Food
Like food, drugs taken by mouth must be absorbed through the lining of the stomach or the small
intestine. Consequently, the presence of food in the digestive tract may reduce absorption of a drug.
Often, such interactions can be avoided by taking the drug 1 hour before or 2 hours after eating.

Dietary supplements
Dietary supplements, including medicinal herbs, are products (besides tobacco) that contain a
vitamin, mineral, herb, or amino acid and that are intended as a supplement to the normal diet.
Supplements are regulated as foods, not as drugs, so they are not tested as comprehensively.
However, they may interact with prescription or over-the-counter drugs. People who take dietary
supplements should tell their doctors and pharmacists, so that interactions can be avoided.

Alcohol
Although many people do not consider alcohol a nutrient, it affects body processes and interacts with
many drugs. For example, taking alcohol with the antibiotic metronidazole can cause flushing,
headache, palpitations, and nausea and vomiting. Doctors or pharmacists can answer questions
about possible alcohol and drug interactions.

Affected Drug Interacting Food Interaction

Bisphosphonates (such
as alendronate, ibandronate,
and risedronate)
Certain benzodiazepines
(such as triazolam)
Grapefruit juice
Food, even orange juice, coffee, or
mineral water, may markedly reduce the
Any food absorption and effectiveness of these
drugs. Alendronate and risedronate must
be taken with plain water at least 30
minutes before the first food, beverage,
or drug of the day is taken,
and ibandronatemust be taken at least 1
hour before.
Grapefruit juice inhibits enzymes
involved in drug metabolism and thereby
intensifies the effect of certain drugs,
including many that are not listed here.
 2. Allergic drug reactions are not dose-related but require prior exposure to a drug. Allergic
reactionsdevelop when the body's immune system develops an inappropriate reaction to a
drug (sometimes referred to as sensitization). After a person is sensitized, later exposures to
the drug produce one of several different types of allergic reaction. Sometimes doctors
do skin tests to help predict allergic drug reactions.

Skin testing
Skin tests are the most useful way to identify specific allergens.

Usually, a skin prick test is done first. Dilute solutions are made from extracts of pollens (of trees,
grasses, or weeds), fungal spores, dust mites, animal dander, insect venom, foods, and some drugs. A
drop of each solution is placed on the person’s skin, which is then pricked with a needle.

Doctors may also use other solutions to help them interpret the person's response to the allergens. A
drop of a histamine solution, which should trigger an allergic reaction, is used to determine whether
a person's immune system is working. A drop of diluting solution, which should not trigger an
allergic reaction, is used for comparison.

If the person is allergic to one or more of the allergens, the person has a wheal and flare reaction,
indicated by the following:

 A pale, slightly elevated swelling—the wheal—appears at the pinprick site within 15 to 20

minutes.
 The resulting wheal is about 1/8 to 2/10 inch (about 0.3 to 0.5 centimeters) larger in
diameter than the wheal caused by the diluting solution.
 The wheal is surrounded by a well-defined red area—the flare.

The skin prick test can identify most allergens.

If no allergen is identified, an intradermal test is done. For this test, a tiny amount of each
solution can be injected into the person’s skin. This type of skin test is more likely to detect a reaction
to an allergen.

Before skin tests are done, people are asked to stop taking antihistamines and certain
antidepressants called tricyclic antidepressants (such as amitriptyline) and monoamine oxidase
inhibitors (such as selegiline). These drugs may suppress a reaction to the tests. Some doctors also
do not test people who are taking beta-blockers because if such people have an allergic reaction, the
consequences are more likely to be serious. In addition, beta-blockers may interfere with the drugs
used to treat serious allergic reactions.